| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,737 |
1,246 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
3,145 |
3,144 |
$62K |
| D1110 |
Prophylaxis - adult |
2,214 |
2,211 |
$42K |
| D1120 |
Prophylaxis - child |
1,266 |
1,266 |
$25K |
| D0274 |
Bitewings - four radiographic images |
2,143 |
2,140 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,243 |
2,238 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,820 |
2,816 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
245 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
486 |
483 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
168 |
142 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
949 |
949 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
200 |
$4K |
| D0272 |
Bitewings - two radiographic images |
603 |
602 |
$3K |
| D1206 |
Topical application of fluoride varnish |
205 |
205 |
$1K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$640.00 |
| D0270 |
|
90 |
90 |
$267.00 |
| D0190 |
|
36 |
36 |
$0.00 |